Why do doctors not want Medicare patients?

Some doctors don't accept Medicare primarily due to lower reimbursement rates compared to private insurance, excessive paperwork, and complex administrative rules, making it less profitable or more burdensome for their practice, especially smaller ones, leading them to "opt-out" to set their own fees or focus on private patients. Doctors can choose to participate (accepting Medicare's rates), be non-participating (charging up to 15% more), or completely opt-out (billing patients directly, with Medicare paying nothing in emergencies).

Why are doctors not accepting Medicare?

One of the most common reasons is that they do not feel that the reimbursements provided by Medicare cover the costs associated with providing care for these patients. Additionally, some doctors may have concerns about the paperwork or bureaucracy that comes along with treating Medicare patients.

What does Dave Ramsey say about Medicare?

Dave Ramsey's Medicare advice centers on planning ahead, understanding enrollment periods to avoid penalties, using Health Savings Accounts (HSAs) if possible, and supplementing Original Medicare with Medigap or Medicare Advantage (Part C) to cover gaps like dental, vision, and long-term care, stressing that mistakes can be costly and recommending expert advice for personalized choices. 

Is it better to go on Medicare or stay on private insurance?

Neither Medicare nor private insurance is universally "better"; the best choice depends on individual needs, but Medicare often offers lower overall costs and simplicity for seniors, while private insurance excels in covering dependents and potentially offering more choice with networks/out-of-pocket caps, though at higher premiums. Medicare boasts lower admin costs and standardized coverage, but Original Medicare lacks an out-of-pocket maximum, a feature typically found in private plans and Medicare Advantage (Part C). 

Why are so many doctors dropping Medicare patients?

Physician Medicare reimbursement dropped 33% since 2000, when adjusted for inflation, according to the AMA. As a result, Ferguson said, many practices—particularly small, independent ones—can no longer afford to absorb the losses. "It's gotten to a point where you can't absorb it.

5 Things Medicare Doesn't Cover (and how to get them covered)

Do doctors get paid less for Medicare patients?

Yes, many doctors, especially in primary care and small practices, often lose money or operate at a significant financial strain with Medicare patients because reimbursement rates are frequently too low to cover overhead, leading some to limit new Medicare patients or opt out entirely, though this varies by specialty and practice size. Medicare's payment system pays less than private insurance, and these rates haven't kept pace with rising practice costs (staff, rent, tech), causing financial pressure. 

Is it better to have straight Medicare or a Medicare Advantage plan?

Neither Original Medicare nor Medicare Advantage (MA) is inherently "better"; the best choice depends on your health, budget, and lifestyle, with Original Medicare offering provider freedom and MA providing bundled benefits (dental/vision) and cost predictability via an out-of-pocket maximum, but often with network restrictions. Choose Original Medicare + Medigap for nationwide access and no networks, ideal for travelers or those wanting maximum choice, while Medicare Advantage suits those wanting all-in-one coverage (including drugs/extras like dental/vision) with lower upfront costs and a cap on yearly spending, provided they stay in-network. 

What are the biggest mistakes people make with Medicare?

The biggest Medicare mistakes involve missing enrollment deadlines, failing to review plans annually, underestimating total costs (premiums, deductibles, copays), not enrolling in a Part D drug plan with Original Medicare, and assuming one-size-fits-all coverage or that Medicare covers everything like long-term care. People often delay enrollment, get locked into old plans without checking for better options, or overlook financial assistance programs, leading to higher out-of-pocket expenses and penalties. 

What are the 5 things Medicare doesn't cover?

Medicare generally doesn't cover long-term care, most dental care, routine vision services (like glasses), hearing aids/fittings, and cosmetic surgery, though it does provide strong coverage for hospital and doctor services; you can often get coverage for these gaps through Medicare Advantage (Part C) or supplemental plans. 

What is the best secondary insurance if you have Medicare?

Best Medicare Supplement Insurance Companies in 2026

• UnitedHealthcare / AARP – Best Plan Pairing: Plan G or Plan N.
• Cigna Healthcare – Best Plan Pairing: Plan G.
• Humana – Best Plan Pairing: Plan N.
• Aetna (CVS Health) – Best Plan Pairing: Plan N.

Do wealthy retirees use Medicare?

Medicare Costs for High-Net-Worth Individuals

Unlike Social Security benefits, Medicare premiums are means-tested, meaning higher-income retirees pay more for coverage. This makes Medicare planning for high-net-worth individuals crucial to managing healthcare costs effectively.

At what point is full coverage not worth it?

Full coverage isn't worth it when your car's low value (e.g., less than 10x annual premium) doesn't justify the cost, you have savings to cover repairs/replacement, the vehicle is paid off, or you can't afford a high deductible, especially if the car is older and the payout won't cover much after deductible. It becomes a bad deal when the cost of premiums outweighs the actual cash value (ACV) of your car and your financial ability to self-insure for damages. 

What did Suze Orman say about social security?

Dave Ramsey suggests claiming Social Security at 62 and investing the money. Suze Orman advises waiting as long as possible and ideally until 70 to claim benefits. Orman's advice is more likely to be the right move for most seniors.

What health insurance denies the most?

In 2023, roughly one third of all in-network claims made to AvMed were denied by the medical insurance company. In this year, AvMed and United HealthCare were the medical insurance companies with the highest denial rate for in-network claims in the United States, at 33 percent each.

Why have many physicians started refusing patients who are on Medicare?

In recent years, physician groups and some policymakers have raised concerns that physicians would opt out of Medicare due to reductions in Medicare payments for many Part B services, potentially leading to a shortage of physicians willing to treat people with Medicare.

What will the Medicare premiums be in 2026?

For 2026, the standard Medicare Part B premium is $202.90 monthly, an increase from 2025, with higher earners paying more through Income-Related Monthly Adjustment Amounts (IRMAA) based on their 2024 income. Part A premiums are typically free for most, but those who pay can see increases up to $565/month. Part C (Medicare Advantage) plans vary, while Part D (prescription drug) premiums also vary by plan. 

What blood tests does Medicare not cover?

Medicare generally doesn't cover blood tests that aren't medically necessary, such as routine wellness panels, employment-required tests, elective tests for general curiosity, or experimental markers, though it does cover specific preventive screens (like PSA) and medically indicated diagnostic tests. You'll likely pay out-of-pocket for tests ordered without a specific diagnosis, tests done too frequently, or those for general "peace of mind," but your doctor should give you an Advance Beneficiary Notice (ABN) if a test isn't covered. 

Does Medicare pay 100% for anything?

No, Original Medicare (Part A & B) does not cover 100% of costs; it typically pays about 80% after deductibles, leaving you with 20% coinsurance for many services, plus gaps like dental, vision, and most drugs, requiring you to pay out-of-pocket or get supplemental coverage like Medicare Advantage (Part C) or Medigap. Some preventive services are covered at 100%, but most care has cost-sharing. 

Does Medicare pay for a colonoscopy?

Yes, Medicare (Part B) pays for screening colonoscopies, covering 100% of costs if your doctor accepts assignment and no polyps are found, though you pay 15% if they remove tissue (making it diagnostic); frequency depends on your risk, generally every 10 years (average risk) or 24 months (high risk). 

Is it better to have plain Medicare or Medicare Advantage?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

What will happen to Medicare in 2025 for seniors?

In 2025, the biggest Medicare changes for seniors focus on Prescription Drug coverage (Part D) with a new $2,000 annual out-of-pocket cap, eliminating the "donut hole," allowing monthly payments for drug costs, and introducing price negotiations, while Medicare Advantage plans face potential benefit adjustments, and Part B premiums and deductibles will increase. Expect some MA plans to reduce extra perks to offset new drug costs, plus updates to telehealth and integrated care options. 

What are the three words to remember for a Medicare wellness exam?

For a Medicare Wellness Exam's cognitive test, the three common words to remember are often "banana," "sunrise," and "chair," used in the Mini-Cog screening to check your memory and thinking skills; you say them immediately and then recall them after a few minutes. 

What is the best health insurance for seniors on Medicare?

There's no single "best" health plan, as it depends on your needs, but top providers for Medicare Advantage (Part C) include Humana, UnitedHealthcare, Aetna, and BCBS, offering diverse benefits like $0 premiums, extra perks, and strong networks, while Medigap (Medicare Supplement) complements Original Medicare by filling gaps, with popular carriers like AARP/UHC, Anthem, and Cigna providing standardized policies (Plans G, F, N), with personalized choices best found via your State SHIP counselor or broker. 

Can I drop my Medicare Advantage plan and go back to original Medicare?

Yes, you can drop your Medicare Advantage (MA) plan and return to Original Medicare, typically during the Annual Enrollment Period (AEP) (Oct 15–Dec 7) or the MA Open Enrollment Period (OEP) (Jan 1–Mar 31), though you may qualify for a Special Enrollment Period (SEP) if you move or have other qualifying life events, but be aware you'll need to get a Part D plan and might want a Medigap plan to help with costs. 

What states have the worst Medicare Advantage plans?

States often cited for weaker Medicare Advantage performance include Louisiana, Mississippi, Kentucky, West Virginia, and Florida, due to challenges with care access, provider shortages, and quality issues like higher rates of avoidable hospitalizations and inappropriate medication prescriptions, though specific rankings vary by report and focus (e.g., satisfaction vs. overall system). Other states like New York, California, Texas, and Michigan appear on lists for low member satisfaction with specific plans, not necessarily the whole state's system.